Is localized twitching that has spread to the rest of the body suggestive of ALS?

Hello,

Welcome to icliniq.com.

I understand your concern.

I would like to know some details about your symptoms:

• Are these twitches visible by eyes, or are they only felt inside?
• Have you noticed any situations when these twitches get worse?
• Did you notice any thinning of muscle bulk in any limb?
• Do you have any weakness in hand grip or lifting any object overhead?
• Do you have any difficulty swallowing liquids or solid food?
• Do you have any neck or arm pain or tingling?
• How is your usual mood in the daytime? Is it happy, sad, or worried?
• How is your sleep? How long does it take for you to fall asleep after lying on the bed? Do you wake up in between sleep?
• Do you have any other medical problems? Are you on any regular medications? if yes, please mention the names and doses.
• Apart from EMG, have you undergone any other investigation? if yes, please send reports as attachments.

Kindly revert with the answers to the above questions.

Thank you.

Hello,

Welcome back to icliniq.com.

There is one attachment that you have shared (attachment removed to protect the patient's identity) and it is the nerve conduction study findings and not an EMG (electromyography) report. Also, I am curious to know for which medical symptoms you underwent MRI (magnetic resonance imaging) three years ago and MRI of which body part?

As per your description, there is a possibility that you might be having fasciculations. There can be numerous reasons for fasciculations. The common one is benign fasciculation syndrome. Also, it can happen due to anxiety or in a denervated muscle. Other rare causes are cramp-fasciculation syndrome and ALS (amyotrophic lateral sclerosis).

As you have mentioned that there is no clinical weakness in arm strength, but there is a dent in the forearm; it needs to be assessed if it is new or there since before. Also, you need a detailed clinical neurological examination, particularly the deep tendon reflexes. Twitches alone do not point toward ALS. ALS is a progressive disease and, in an early stage, can have only fasciculations. But with time, other signs and symptoms appear. If signs and symptoms fit into ALS diagnostic criteria, only then is ALS diagnosis feasible. Moreover, there is no investigational test to diagnose or rule out the condition. ALS is a clinical diagnosis only after ruling out other possibilities which can mimic those symptoms.

I hope this helps.

Thank you.